Metabolic Bone Dis Flashcards
OP mx
BisP cause clast apop. Zoledronate annual infus. AE- atyp frac, nec jaw, oesophagitis. NOT in preg.
Denosumab MAb blocks RANKL prevs clast activat and prolif. Injec ev 6mnth. Safe.
Ca and vit D.
Less used- HRT, raloxifene SERM, strontium ranelate, PTH analogue teriparatide for v sev.
Osteomalacia
Decr min of osteoid in adult, abn cartil in kids.
Low vit D
Px- bone and musc pain, frac, prox weak, fatigue, waddle.
Ix- high ALP, high PTH, low/norm Ca and P. DXA. XR if frac or verteb.
Mx- cholecalciferol, alfacalcidol, calcitriol.
Bloods
Pagets- high ALP, normal Ca
CA- high ALP, high Ca
OP- normal both
Also test- FBC, ESR, UE, LFT, Ca, P, TFT, testost, PA, serum Igs
T1 post menop
Oestrogen blocks clasts
OP mx
Lifestyle- ex, alc, amok Fall assess Ca and vit D BisP- atyp frac, jaw nec, not in preg Teriparatide PTH analogue only if V SEV Denosumab blocks clast prolif and activ, 6mnthly injec HRT, raloxifene, strintium ranelate Surg for frac
RF
Post menop Age Fam hx RA, IBD Malnutrit Steroids Smok and alc
Secondary OP
Menop Hyperthyr, hyperPTH DM Cushings IBD Liver dis Coeliac Bm disorder
preven of steroid induced OP
Use bisP if over 5mg pred over 3mnth IF-
Over 65
Under 65 and T score under -1.5
dual xray absorptiometry
Use- predict frac risk, dx osteopenia and OP, steroid prophylaxis.
T is SD from mean yng person same gender and ethnicity. Frac risk. Over -1 ok. -1 to -2.5 penia. Under -2.5 OP.
Z is SD from weight, gender and age matched popn. Abn under -1.8
FRAX 10yr frac risk
Age Sex BMI Prev frac Smok Ster RA OP Alc Fem T score
fall RFs
Age Prev fall Cog impair Bal or ait prob Weakness Multip meds Vis probs Foot probs
